Mental Health Occupational Therapy
Sensory Integration and Sensory Stimulation
Guidelines
Created by: Sensory Integration Task Group
Created: January 2015
Review date: January 2016
Contents Page
Introduction to Sensory Integration
Page Number
2
Sensory Integration Leaflet
3
Sensory Integration Pathway
4
The Multisensory Equipment
5
Sensory Integration Group Protocol
7
Sensory Tools
10
Sensory Ladder & Example
10 - 13
Sensory Spider
14 - 17
Sensory Preferences Tool
18 - 22
Sensory Diet Exploration: Activity Checklist
23 - 25
Risk Assessments
26 - 35
The Use of Sensory Integration in Mental Health
36 - 38
The Use of Sensory Integration in Learning Disabilities
39 - 42
The Use of Sensory Integration in Older Adults
43 - 47
Appendix 1 - Infection Control Record Form
48
References and Further Reading
49 - 58
Directory of Occupational Therapists with Further Training in Sensory Integration
59
1
Introduction to Sensory Integration
Sensory Integration (SI) is “the organization of sensory input for use” (Ayers
1979, p.p 184). Behaviour is governed by the way the brain processes and
interprets sensations. Difficulties processing the sensory information i.e. sensory
processing disorders, effects individuals behaviour. Individuals may have
difficulty with concentration, motivation, impulsivity, coping with emotions and
relationships. This may lead to them being unable to function and cope with
everyday aspects of their lives. SI fits in well with the concepts of Occupational
Therapy (OT), enabling individuals to maintain their daily occupational
performance. Individuals need to balance arousal levels through sensory stimuli,
registering, modulating and discriminating between sensory information in order
to function at an optimum level in their everyday lives (Bundy, Lane et al 2002,
Roley, Blanche et al 2007). The ability to process sensory information is central
to individual’s ability to maintain their everyday occupations (Roley, Blanche et al
2001).
These guidelines are intended for use by occupational therapy staff (including
assistants and students) who have an interest in Sensory Integration and wish to
implement the theory into practice. The intention of the guidelines are not to fully
inform professionals of the theory but to introduce the theory and tools that can
be used when implementing this into occupational therapy practice and to
provide management of potential risks. The guidelines suggest that occupational
therapy staff and students should complete training to enable them to deliver
Sensory Integration and the same would apply to other professional groups. To
administer the standardised assessments Level 1, 2 and 3 of the Sensory
Integration University of Ulster Masters should be completed.
2
Sensory Integration Leaflet Link
3
Sensory Integration Pathway
Identify service user has sensory needs e.g. self harm, challenging
behaviour, resistive behaviour to personal care, isolative/avoiding
behaviour
Initial discussion regarding SI and provide service user/carer/staff SI
leaflet to introduce concept
Consider possible interventions
(SI group, sensory soothe/stimulation boxes, changes to
environments) documenting in care plan.
Complete initial non standardised sensory assessments e.g.
sensory preferences tool, sensory ladders.
Feedback findings to MDT
Consider
more
complex
sensory
integration
assessment –
those
qualified to
conduct this
can be
contacted for
advice (see
end of
document for
details)
Evaluate progress with service user/carer/staff.
Contact OT with additional training in SI for supervision and
guidance (see contact list)
4
MULTISENSORY EQUIPMENT
Fibre-Optic Sprays
Aims of using the equipment:
 For relaxation – can be used with other equipment to set up an environment
for relaxation
 Gain a person’s attention.
 Provide visual stimulation.
 Provide tactile stimulation i.e. people can hold the fibres and feel them.
 Motivate people to reach out and hold objects.
Bubble Tube
Aims of using the equipment:
 Gain attention.
 Provide visual and tactile (touch)/ movement (vibration) stimulation.
 Create a relaxing environment.
 Encourage visual tracking (watching the bubbles)
Colour projector
Aims of using the equipment:
 For relaxation – it can be used with other equipment (quiet music to set up an
environment for relaxation)
 Gain a person’s attention.
 Display people’s art work as a topic of conversation.
 Provide visual stimulation and visual tracking.
 Use as a visual aid to teach a task.
 Develop cognitive skills (e.g. colours, picture recognition)
Mirror Balls
Aims of using the equipment:
 For visual stimulation.
 For visual tracking.
 Motivate people to attend to task.
 Help create a relaxing environment.
Sound System
Aims of the equipment:
 Provide music to create a relaxing environment.
 Provide music to create a stimulating environment.
 Provide auditory stimulation and show a person’s reaction to sound – use
everyday sounds, different types of music, people’s voices.
 Experiment with sound (e.g. loud/soft, different rhythms, encouraging
vocalisation).
 Experiment with hearing listening and making sounds.
5
Aroma Diffusers – please see Complementary Therapies policy
Aims of the equipment:
 Use it with other equipment (e.g. quiet music to set up an environment for
relaxation.)
 Offer an opportunity to make choices, e.g. which scent to use.
 Use other oils (e.g. lavender oils) to create a stimulating environment.
 Use it to create a particular environment (e.g. Flowers for outside)
 Use it to stimulate a sense of smell.
Items that can also be used to create a multi-sensory environment
 A variety of fabrics with varying textures and colours
 Everyday objects that make different sounds e.g. plastic bottle with rice
inside can be a rain maker
 Dough – bread making can be used for tactile and proprioceptive
stimulation
 Weighted blankets – layering of clothes and blankets can give the same
effect
 Flowers and plants
 Koosh balls and tanglers (used to help relive stress)
 Music
 Air cushions/balance cushions
 Clay
 Variety of smells
Possible Sensory Integration Group/Individual Session
Rationale:
As part of a group a sensory approach can be taken to look at coping strategies
for anxiety, low mood, challenging behaviour, registering, modulating and
discriminating difficulties plus others. This type of group address alerting and
calming techniques to assist in regulating arousal levels throughout the day to
maximise optimal functioning.
Aims and objectives:
 Offer an introduction to sensory coping strategies
 Improve awareness of how to cope with individual symptoms/difficulties
 Allow service users to discuss difficulties and coping strategies in a safe
environment
 Encourage ways to manage negative thoughts and behaviours
 Provide a forum for information and discussion
 Provide therapeutic structure and routine to service users day/week
Members:
If this is used as a group format there should be a maximum 8 service users to
allow for sharing and positive group work. Things to take into consideration are
6
room size, client group, therapist capacity and level of service user cognition.
This group can be a closed or open dependent on the service delivery.
Facilitation:
To be facilitated by a minimum 1 member of staff whom has some
training/knowledge around Sensory Integration to understand the theory. More
facilitators will be required if group size demands.
Ground Rules:
To be agreed by OTs and members of the group at the beginning of each
session. To include
 All issues discussed within group remain confidential within group and to
MDT
 Everyone’s contribution is important and will be respected
 Any verbal/physical abuse to self/others/environment will be managed
appropriately and the relevant individuals will be informed of the outcome
 As per group protocol encouragement given for one person to speak at a
time
Risk Management plan will be documented and will include infection control
process regarding cleaning/decontamination of tactile equipment. Issues such as
allergies will be considered and the use of flashing/bright lights which may trigger
migraine, epilepsy will be documented in service users records. Before each
session an informal risk assessment to be completed to ascertain the service
users current mental health and behaviour for participation. This process should
be recorded in the service users records.
Week 1:
Introduction to sensory strategies and sensory spiders
Introduce group aims, ground rules and round of introductions.
Taster session:
Resources:
Flip chart
Sensory spider sheets
CD player
Items as below:
Salty (e.g. salt and vinegar crisps)
Sweet (e.g. chocolate)
Sour (e.g. sour sweets)
Crunchy (e.g. celery)
Fizzy (e.g. fizzy pop)
Soft (e.g. teddy bear, silk)
Scratchy (e.g. netting, scourer)
Squashy (e.g. stress ball)
Gustatory/Olfactory
Gustatory/Olfactory
Gustatory
Gustatory/Tactile
Gustatory/Tactile
Tactile
Tactile
Tactile
7
Bubble wrap
Tactile/Proprioceptive/Auditory
Vibrating pillow
Tactile/Proprioceptive
Bright lights
Visual
Dim lights (e.g. lava lamp)
Visual
Different music (e.g. loud, soft, relaxation, pop) Auditory
Flowers
Olfactory
Self care products (e.g. shampoo, body gel)
Olfactory
Encourage service users to engage in trying out all sensory items, use as many
or few as wanted, can focus on one sense or look at all sensory input.
Encourage all service users to discuss what they like/don’t like/things that aren’t
available to try that they enjoy etc.
Discuss 5 main senses and how environment can influence arousal state.
Flip chart- focus on one sense and discuss how different sensations can be
calming, alerting and distressing. Begin by discussing pleasant and unpleasant
sensations then make clear the distinction between calming and alerting
sensations. Highlight that one sensation can be different for different people.
Get group to offer suggestions what they find calming, alerting and distressing.
Demonstrate sensory spiders-calming and alerting and encourage group to
transfer information discussed onto individual spiders.
Dependent on time/group size continue with other senses as group.
Homework:
For group members to continue with sensory spiders
(OT to take photocopy of partially completed sensory spider in preparation for
second group in case these are not brought back)
Week 2:
Ladders and sensory spiders
Room set up:
Relaxation music, dim light, lava lamp, tactile sensory equipment
Discuss information offered in previous week, group aims, group rules and round
of introductions.
Hand out sensory spiders from previous week/new ones for those who are new
to group. Use environment as discussion point for calming spider.
Flip chart- discuss senses, thought shower ideas for all 5 senses.
Flip chart- introduce sensory ladder including how arousal states should increase
and decrease throughout day, benefits of being hyper- and hypo- aroused.
8
Discuss individual’s needs to either increase or decrease arousal levels. Start
ladders.
Homework:
For group members to complete sensory ladder
(OT to take photocopy of partially completed ladder in preparation for next group
in case these are not brought back)
Week 3
Sensory sooth box
Resources:
Completed sensory box, e.g. decaf tea, light box, material, enjoyable/meaningful
activity, self care items, candle, photo, CD,
Discuss information offered in previous week, group aims, group rules and round
of introductions.
Talk through items in sensory box and reasons for these items, talk through
possibilities for sensory boxes for individuals in group. Make lists of items
possible for box (keep in mind risk assessments for items allowed on acute unit
v. items they might have in more long term sensory box at home).
Complete sensory ladders and spiders.
Possible 1:1s post group:
Community escorts to source items for box
9
Sensory Tools
Sensory checklists, sensory spiders and sensory ladders can all be used to
help you:
o Use sensory integration principles in practice
o Work with service users who may not have a diagnosed sensory
processing disorder but make you think ‘sensory’
o Explain ‘SI’ to service users
o Offer service users alternative explanations to their behaviour and
reactions
Sensory Ladders
Remind us that we can be both under and over alert
‘Shutdown’ can appear as under-alert at first glance
‘Just – right’ Zone is where we will function best
Could be referred to as a stress/anxiety ladder (example attached)
Functioning




Arousal
Sensory Spiders



‘Sensory Spiders’ consider 8 areas of sensory input for their self –
regulating properties
3 different ‘Sensory Spiders’ to use:
o Alarming/Distressing (Alert Upset)
o Alerting (Alert Awake)
o Calming
Components from Calming Spider may lead to ideas for a sensory soothe
box
10
Sensory Preferences Tool/Sensory Diet Exploration




Lists activities that many people do during the day to modulate and
regulate emotions and arousal levels
Can raise a persons awareness to something they do regularly without
even realising
Checklist reduces need to ‘think on the spot’
May identify triggers – activities that distress or alarm
11
Sensory Ladder
How do I present?
Scale
How do I feel?
What can I do/Action to take
Shutdown
10+
10
9
Over Alert
8
7
Calm and Alert
6
5
4
Hypo responsive
3
2
1
0
12
How do I present?
Scale
How do I feel?
What can I do/Action to take.
Shutdown
I self harm
I want to die
I hide away
I have difficulty talking.
I don’t cope with other people very
well
10+
10
I feel suicidal
I don’t feel safe
I feel as if I can’t talk to people
Take my medication
Have a bath in warm water with lavender
bubble bath
Put on some soft music while I get dry
9
Ideas from ‘Calming Spider’
Over Alert
I cry
I shout out
I bang doors
8
I feel confused, agitated and anxious.
7
Look at my favourite photos
Watch a comedy video (such as you’ve
been framed)
Talk to the staff
Go for a walk
And use my sensory box.
Calm and Alert
I talk to people
I like to laugh and joke.
6
I feel rational, calm and able to make
decisions.
I can go shopping with other patients
I can go to Quest
I can attend groups on the ward.
5
4
Hypo responsive
3
I stay in bed
2
1
0
I feel sleepy and don’t want to do
anything.
I will set my alarm clock for 10.30 and ask
the staff to wake me if I don’t get up at this
time.
I will have a coffee followed by a shower
with strong shower gel. Have my music on
while I get dry, then go for a walk in the
grounds
Ideas from ‘Alerting Spider’
13
Vestibular
Chemical
Proprioception
Sensory Spider
Sound
Vision
Smell
Taste
Touch
14
Auditory
Proprioception
Vision
Vestibular
Alert
Taste
Tactile
Smell
Chemical
15
Auditory
Proprioception
Vision
Vestibular
Calm
Taste
Tactile
Smell
Chemical
16
Auditory
Proprioception
Vision
Vestibular
Distress
Taste
Tactile
Smell
Chemical
17
Sensory Preferences Tool
Potential uses for tool:
 Increase understanding of individuals and their unique challenges.

Explore environmental preferences.

Inform our intervention – helping to predict individuals’ responses to
situations and help to minimise risk of a negative outcome.

Help increase self-awareness and minimise transference- being aware of
our own sensory preferences and how we may transfer these to the
activities we carry out with individuals e.g. relaxation sessions.
Who to use it with:
 Individuals looking to relax/ calm- easily over stimulated or wanting to
overcome anxiety in difficult situations e.g. hospital, supermarket, public
transport.

Individuals looking to become more alert – e.g. drowsy, struggling to
motivate self in mornings.

Individuals seeking new/ temporary accommodation, or access to work/
educational/ leisure facilities.

Individuals who engage in self-harming/ destructive behaviour- To explore
if there is a sensory function to this behaviour? Are there less destructive
activities which might stimulate the same effect/ response?
How to apply findings:
 Creating a sensory toolkit - shop around with individual for items which
stimulate or relax (according to need) that can be utilised when required
e.g. CD’s/ MP3, scented candles, tactile objects/ keyrings, wind chimes,
scented shower gels, body scrubs, chewing gum.

Look at daily routine and activities- are there any adjustments that can be
made to better suit the individual’s sensory needs? E.g. make time to
engage in sports/ activities which have a calming or alerting effect e.g.
weights, gardening, trampoline. Are there any products which will assist
relaxation or stimulation? E.g. lavender oil, citrus shower gel.

Look at the environments the individual encounters- are there any
alterations that can be made to better suit their sensory needs? E.g. black
out blinds, paint colour, heavy duvet, subtle lighting, fish tank.
Compiled by S. Southwell and B. Jobson (2008) for use in Community Mental Health (Occupational
Therapy) in Shropshire and Telford & Wrekin.
Informed by the work of K. Smith and A. Turner (2002) (Cornwall Partnerships NHS Trust), originally
adapted from “How Does Your Engine Run?” A Leader’s Guide to the Alert Program for Self
Regulation. (1996) M. S. Williams and S. Shellenberger.
18
Name:
NHS Number:
Like
Dislike
Don’t mind
Comments e.g. relaxing or
alerting? Actively seeking
or part of normal routine?
Sounds/ auditory
Music:Loud
Soft
Jazz
Rock
Classical
Country
Dance/ trance
Heavy metal
Choir
Drums
Singing
Whistling/ humming
TV (+ volume)
Background noise
Traffic
Clock ticking
Wind chimes
Unexpected noise-dog
bark/ bell/ alarm
Other
Like
Dislike
Don’t mind
Comments
Smells/ olfactory
Flowers
Perfume
Cleaning products
Petrol/ diesel
Tar
Rain
Paint
Baking cakes
Laundry
Coffee
Toast
Cut grass
Bonfire/wood smoke
Other
Like
Dislike
Don’t mind
Comments
Sights/Visual
Bright light
Light rooms
Dark rooms
Bright colours
Dark colours
Natural colours
Watching a fish tank
Watching candles
Watching a fire
Lava lamp
Cinema
Other
19
Like
Dislike
Don’t mind
Comments
Like
Dislike
Don’t mind
Comments e.g. relaxing or
alerting? Actively seeking
or part of normal routine?
Movement
Walking
Rocking
Spinning around
Swinging
Climbing
Biking
Gym work/ weights
Running
Swimming
Trampoline
Digging
Boxing/ punching
Adrenaline sportsbungee/ skiing/ surfing
Other
Like
Dislike
Don’t mind
Comments
Textures/ tactile on
body
Brushing teeth
Brushing hair
Washing hair
Cutting hair
Washing face
Bathing
Hot water
Cold water
Showering
High pressure water
Low pressure water
Body scrub/ sponges
Cutting nails
Clothing-
Like
Dislike
Don’t mind
Comments
Chemicals
Caffeine (coffee/coke)
Nicotine
Alcohol
Other
Body Contact
Being close to others
Eating with others
Crowds
Touch from others:
Light touch/ tickle
Deep touch/ massage
Hugs
Banging head into
objects/ furniture
Pressing head into
objects/ furniture
Pressing body into
objects/ furniture
Other
20
Labels
Fabrics-cotton/wool
Wrapping up in
clothing/ bedding
Tight clothing
Loose clothing
Removing
clothing/undressing
Going barefoot
Other
Taste
Like
Dislike
Don’t mind
Comments e.g. relaxing or
alerting? Actively seeking
or part of normal routine?
Textures/ Tactile in
mouth
Ice cream/ cold drinks
Hot drinks/ food
Fizzy drinks
Spicy/ hot food
Food texturesPeaches
Slimy e.g. Banana/
kiwi
Crunchy e.g. peanuts/
apples
Lumpy e.g. porridge/
mashed potato
Chewy e.g. toffee
Thick e.g. milkshake
Chewing
pens/clothing/objects
Chewing gum
Biting nails
Chewing fist/fingers
Biting objects
Grinding teeth
Sucking thumb
Sucking sweets
Dirty face e.g. food
Other
Like
Dislike
Don’t mind
Comments
Textures/ tactile in
hands
Touching different
fabrics:
Fluffy
Like
Dislike
Don’t mind
Comments
Salty
Sour
Sweet
Creamy
Minty
Fruity
Bitter
Chocolate
Other
21
Woolly
Soft
Scratchy
Prickly
Spiky
Spongy
Slimy
Squishy
Rubbery
Other
Folding arms
Stroking pet(s)
Touching food/ eating
with fingers
Textures/ tactile in
hands (Cont.)
Like
Dislike
Don’t mind
Comments e.g. relaxing or
alerting? Actively seeking
or part of normal routine?
Cracking knuckles/
joints
Pulling fingers/ joints
to ‘click’
Rubbing hands/ body/
objects
Slapping hands/ body/
objects
Sitting on hands
Pinching
objects/people
Playing with spit
Scratching
Hitting/ thumping
Pulling hair
Dirty hands
Other
Completed By:
Date:
22
Sensory Diet Exploration: Activity Checklist
The following is a checklist of things people may use or do in order to help
decrease &/or to prevent distress. Please take a moment to check off those
things that seem to be helpful for you! Each of these activities employs all or
most of the sensory areas. However, they are categorized to help you identify
some of the specific sensorimotor qualities you may want to focus on.
Movement
o Riding a bicycle
o Rocking in a
o Shopping
o Running or
rocker/glider
o Taking a shower
jogging
o Rocking yourself
o Cleaning
o Walking/hiking
o Bean bag tapping
o Driving
o Aerobics
o Shaking out your
o Going on
o Dancing
feet/hands
amusement park
o Stretching or
o Playing an
rides
isometrics
instrument
o Chopping wood
o Lifting weights
o Doodling
o Washing/waxing
o Yoga or Tai Chi
o Re-arranging
the car
o Swimming
furniture
o Skiing/skating
o Jumping on a
o Gardening
o Building things
trampoline
o Yard work
Others:
______________________________________________________________
_
Different Types of Touch & Temperature
o Blanket wrap/weighted blanket
o Using a stress ball
o Getting a massage
o Fidgeting with something
o Holding/chewing ice
o Twirling your own hair
o Soaking in a hot bath
o Going barefoot
o Using arts/crafts supplies
o Getting a manicure/pedicure
o Warming up to a fire/wood stove
o Washing or styling your hair
o Pottery/clay work
o Bean bag tapping/brushing
o Petting a dog, cat, or other pet
o Cooking or baking
o Holding a dog, cat or other pet
o The feel of certain fabrics
o Planting or weeding
o Being hugged or held
o Warm/cold cloth to head/face
o Knitting/crocheting/sewing
o Hot/cold shower
o Being in the shade/sunshine
o Hand washing
o Using powders/lotions
o Washing the dishes
o Playing a musical instrument
Others:
______________________________________________________________
__
Adapted from Wilbarger, 1995 and Williams & Shellenberger 1996; Champagne, 2004
23
Auditory/Listening
o Enjoying the
o Humming
o Using the
quiet
o Whistling
telephone
o The sound of a
o Plays/Theatre
o Use of a
water fountain
o Live concerts
walkman/MP3
o The sound of a
o Radio shows
Player
fan
o Ocean sounds
o Listening to
o People talking
o Rain
musical
o White noise
o Birds chirping
instruments
o Music box
o Ticking of a
o Relaxation or
o Wind chimes
clock
meditation CDs
o Singing
o A cat purring
Others:
______________________________________________________________
___
Vision/Looking
Looking at:
o Waterfalls
o Reading
o Photos
o Cloud
o Looking through
o The sunset or
formations
different coloured
sunrise
o Stars in the sky
sunglasses
o Snow falling
o Ocean waves
o A flower
o Rain showers
o Watching sports
o Water or fish
o Fish in a tank
o Movies
swimming in a
o Autumn foliage
o Animal watching
lake
o Art work
o Window
o Looking through
o A bubble lamp
shopping
picture books
o A mobile
o Photography
Others:
______________________________________________________________
___
Olfactory/Smelling
o Scented Candles
o Flowers
being hung
o Essential oils
o Tangerines/citrus
outside to dry
o Cologne/perfume
fruits
o Scented lotions
o Baking/cooking
o Herbs/Spices
o Incense
o Coffee
o Chopped wood
o Herbal tea
o Aftershave
o Smell of your pet
o Mint leaves
o Freshly cut grass
o Linens after
Others:
______________________________________________________________
__
Adapted from Wilbarger, 1995 and Williams & Shellenberger 1996; Champagne, 2004
24
Gustatory/Tasting/Chewing
o Chewing gum
o Biting into a
o Mints
o Crunchy foods
lemon
o Hot balls
o Sour foods
o Eating a lollipop
o Chewing carrot
o Chewing ice
o Drinking
sticks
o Sucking a thick
coffee/cocoa
o Spicy foods
milkshake
o Drinking herbal
o Eating a popsicle
through a straw
or regular tea
o Blowing bubbles
o Chewing on your
o Drinking
o Chocolate
straw
something
o Strong mints
o Yawning
carbonated
o Deep breathing
o Listerine strips
Others:
______________________________________________________________
Additional Questions:
What kind of music is calming to you?
______________________________________________________________
What kind of music is alerting to you?
______________________________________________________________
Do you prefer bright or dim lighting when feeling distressed?
______________________________________________________________
Are there other things that are not listed that you think might help? If so,
what?
______________________________________________________________
______________________________________________________________
______________________________________________________________
After reviewing all of the activities you have checked off and listed, what
are the top
five things that are the most helpful when you are feeling distressed?
1. _________________________________________________________
2. _________________________________________________________
3. _________________________________________________________
4. _________________________________________________________
5. _________________________________________________________
25
Risk Assessments
Appendix 1a
RISK ASSESSMENT FORM (for clarity please print)
Risk Assessor: Sensory Integration Special Interest Group
Date of Assessment: 07/01/15
Location of Assessment: n/a
Blankets, balls, koosh balls, cushions and vibrating tubes
STEP 1: Summary of Risk / Hazard
1. Spread of infection
2. Allergy to equipment material
3. Harm caused by inappropriate use of equipment
4. Harm caused by poorly maintained equipment
STEP 2: Persons Affected (delete) :
Staff / Client(s)
STEP 3: Evaluate the Risk and identify the Current Controls In Place
1. Effective cleaning schedule of items. Appropriate hand hygiene. Items to be
assigned to specific individuals or cleaned thoroughly between use, record form to
accompany sensory equipment tool box (see appendix 1 for general form to adapt).
2. Staff to be aware of Service User allergies to ensure equipment is safe for their use.
3. Individual Service User risk assessment to ensure appropriate equipment used. Staff
to be aware of equipment instructions and safety precautions and following risk
assessment Service User’s to be supervised if necessary with equipment.
4. Staff to check equipment is safe and intact prior to use, record form to accompany
sensory equipment tool box. Appropriate storage of equipment such as removal of
batteries if stored for long periods with no use.
5. Please be aware of risks of using too much weight with blankets and potential ligature
risk for other all equipment.
Risk Rating (use matrix overleaf)
Impact x likelihood = Risk Rating
3
1
3
FOR ANY ASSISTANCE IN THE COMPLETION
OF THIS FORM PLEASE CONTACT THE
HEALTH AND SAFETY ADVISER ON 01785
257888 EXT 5313
26
STEP 4:
Action Plan
Proposed Actions
Resource Requirements
Target Date
Completed
_______________________________________
STEP 5 Review Date _________________
Risk Rating After Review __
Person/s Responsible ________________________________________________________________
Risk Assessment Guidance Notes
27
Appendix 1a
RISK ASSESSMENT FORM (for clarity please print)
Risk Assessor: Sensory Integration Special Interest Group
Date of Assessment: 06/01/15
Location of Assessment:
Oral/gustatory stimulation for sensory integration therapy
STEP 1: Summary of Risk / Hazard
1. Choking
2. Allergies
3. Diabetes
STEP 2: Persons Affected (delete) :
Staff / Client(s)
STEP 3: Evaluate the Risk and identify the Current Controls In Place
1. Choking on boiled sweets, poor swallowing reflexes. Establish if client has identified
swallowing difficulties. Use measures already in place to ensure safe diet and fluid
intake e.g. thickened fluids, puree diet, supervise eating/drinking. Seek alternative
intervention to provide similar therapeutic effect if client is at high risk of choking.
Referral to Speech and Language Therapist in high risk client groups. Ensure basic
life support/anaphylaxis training is completed as part of mandatory training.
2. Establish if client has any food allergies or intolerances. Check ingredients to ensure
allergen is not present in food/drink product to be consumed as intervention. Be
aware of procedure to follow if allergen is consumed (relative to severity of allergy e.g.
anaphylaxis).
3. Establish if client has diabetes. Use measures already in place to ensure safe diet
and fluid intake e.g. diabetic alternatives, sugar free options. Referral to Dietitian.
Risk Rating (use matrix overleaf)
Impact x likelihood = Risk Rating
3
2
6
FOR ANY ASSISTANCE IN THE COMPLETION
OF THIS FORM PLEASE CONTACT THE
HEALTH AND SAFETY ADVISER ON 01785
257888 EXT 5313
28
STEP 4:
Action Plan
Proposed Actions
Target Date
Completed
Follow above risk management plan. To be aware of increased risks in learning disability
and dementia client group.
Resource Requirements
_______________________________________
STEP 5 Review Date _________________
Risk Rating After Review __
Person/s Responsible ________________________________________________________________
Risk Assessment Guidance Notes
29
Appendix 1a
RISK ASSESSMENT FORM (for clarity please print)
Risk Assessor: Sensory Integration Special Interest Group
Date of Assessment: 06/01/15
Location of Assessment: n/a
Electrical equipment used in SI sessions eg CD players, light bubble machines,
fibre optics, projectors, globe ceiling light.
STEP 1: Summary of Risk / Hazard
1. Broken/faulty equipment
2. Unsafe positioning of electrical equipment
3. Potential harm if electrical equipment were left in an unlocked room/cupboard eg leads
could be used as ligature points
4. Projector – images projected onto walls maybe disturbing to patients due to past
experiences and may exacerbate visual hallucinations
5. Inappropriate use of fibre optics and too close to eyes/face
6. Position of globe ceiling light causes harm to patient eg neck strain. Patient spends
too long in session and difficulty acclimatising to normal light.
7. Equipment is hot due to long usage of it. Potential to burn patient.
8. Infection control – potential for increased risk of spreading infection with shared
equipment
STEP 2: Persons Affected (delete) :
Staff / Clients
STEP 3: Evaluate the Risk and identify the Current Controls In Place
1. Do not use equipment if broken or faulty and report to facilities and estates for repair.
Equipment needs to meet all the Trusts requirements for usage e.g. PAT testing.
2. Ensure electrical equipment is in a safe position, secured onto the wall if necessary or
positioned to minimise potential risk of falls eg avoid trailing leads
3. To keep electrical equipment in a locked room or remove from room and keep in a
locked cupboard. Patient not to be left in isolation with electrical equipment if risks
identified.
4. Discuss patients mental health with MDT and risks associated with images. Speak
with patient about images prior to session. Remain with patient in the room, observe
any signs of distress and ask/advise to leave the room if detrimental to their mental
health.
5. Demonstrate use of fibre optics to patient
6. Be aware of patients positioning regarding ceiling lights. Time limited sessions and
acclimatise them to the light gradually.
7. If possible, provide air circulation to the room. Switch off equipment when not in use.
8. Ensure all equipment where possible is cleaned after use using mild detergent or
soap and water in line with infection control advice.
30
31
Risk Rating (use matrix overleaf)
Impact x likelihood = Risk Rating
3
2
STEP 4:
6
Action Plan
Proposed Actions
-
FOR ANY ASSISTANCE IN THE COMPLETION
OF THIS FORM PLEASE CONTACT THE
HEALTH AND SAFETY ADVISER ON 01785
257888 EXT 5313
Target Date
Completed
Follow above for all staff using electrical equipment in relation to sensory integration
Risk assessment to be made available to all practitioners using sensory integration
through public folders.
Resource Requirements
_______________________________________
STEP 5 Review Date _________________
Risk Rating After Review __
Person/s Responsible ________________________________________________________________
32
Appendix 1a
RISK ASSESSMENT FORM (for clarity please print)
Risk Assessor: Sensory Integration Special Interest Group
Date of Assessment: 07/01/15
Location of Assessment: n/a
Use of olfactory stimulation as part of sensory integration intervention
STEP 1: Summary of Risk / Hazard
1. Scented Oil may cause harm if utilised inappropriately eg if applied to skin (outside
Trust Complimentary Therapy Policy), ingested or spillage occurs.
2. Fire risk associated with use of scented candles
3. Oil burners and joss sticks maybe self harm risks
4. Scented oils may over stimulate the individual, perfumes and oils may cause skin
irritation
5. Olfactory stimulation may increase or decrease the appetite
STEP 2: Persons Affected :
Staff / Clients/ Property
STEP 3: Evaluate the Risk and identify the Current Controls In Place
1. Scented oil to be used for purpose of olfactory stimulation only (unless within remit of
complimentary therapy)
Avoid cross contamination if multi-sensory approach is used.
Oils to be stored in a lockable room when not in use.
Individual oils to be assessed on potential to be harmful if contact is made with skin.
Follow instructions (if available) on action to take if skin reaction occurs.
2. Seek alternatives to scented candles
3. Assess service users risk prior to using or seek alternative
4. Observe during and after intervention for signs of physical, emotional and cognitive
changes
Risk Rating (use matrix overleaf)
Impact x likelihood = Risk Rating
4
2
8
FOR ANY ASSISTANCE IN THE COMPLETION
OF THIS FORM PLEASE CONTACT THE
HEALTH AND SAFETY ADVISER ON 01785
257888 EXT 5313
33
STEP 4:
Action Plan
Proposed Actions
Target Date
Completed
Follow above for all staff using olfactory stimulation in
relation to sensory integration
Risk assessment to be made available to all practitioners
using Sensory Integration through public folders.
Resource Requirements
_______________________________________
STEP 5 Review Date _________________
Risk Assessment Guidance Notes
Risk Rating After Review __
Person/s Responsible ________________________________________________________________
34
Appendix 1a
RISK ASSESSMENT FORM (for clarity please print)
Risk Assessor: Sensory Integration Special Interest Group
Date of Assessment: 06/01/15
Location of Assessment:
Sensory Tools (all have infection control risks)
STEP 1: Summary of Risk / Hazard:Hand Cream – Potential for allergic reactions
Aromatherapy Oils – Could cause contraindications with medication
Fibre optics – Potential to over stimulate, could be used as ligatures or a weapon
Brushing Techniques – Potential damage to fragile skin
Image projectors/ Mirror Balls – Potential to over stimulate, may not be appropriate with
individuals who are experiencing hallucinations or due to mental state
STEP 2: Persons Affected:-Staff / Service users/ Organisation / Carers
STEP 3: Evaluate the Risk and identify the Current Controls in Place:-The above
equipment could be used within individual’s homes, in a sensory room or within the inpatient
wards.
Hand cream - It is advised to access the service users notes and identify any allergies or skin
complaints. If there is no information to guide what creams to use consider a non perfumed
cream designed for sensitive skin. Specific training is available to equip staff without formal
complimentary therapy qualifications to deliver
Aromatherapy Oils – Oils suitable for use are specified within the complimentary therapies
policy. Practitioners using complimentary therapies must be on the trusts complimentary
therapy register.
Fibre optics – The individual needs to be assessed with regards to their sensory needs to
ascertain if this items of equipment is suitable. A risk assessment of their mental state prior to
use is needed and a risk management plan should be completed if individual risks have been
identified. Prior to use the equipment should be cleaned using appropriate wipes to prevent
spread of infections. When the equipment is not in use this should be locked away.
Brushing Techniques – Prior to using this technique individuals sensory needs will be
assessed. Individual’s skin viability will also need to be assessed to ascertain if their skin
would be appropriate for this techniques. Use of assessments within notes is advised (e.g.
waterlow scale).
Image projectors/Mirror balls – Prior to using equipment assess individual’s sensory needs
35 have
to establish if this is appropriate. Individual’s mental state needs to be assessed as could
a detrimental effect on mental health.
Risk Rating (use matrix overleaf)
FOR ANY ASSISTANCE IN THE COMPLETION
OF THIS FORM PLEASE CONTACT THE
HEALTH AND SAFETY ADVISER ON 01785
257888 EXT 5313
Impact x likelihood = Risk Rating
3
X3
STEP 4:
=9
Action Plan
Proposed Actions
Target Date
Completed
Follow above for all staff using sensory tools in
relation to sensory integration
Risk assessment to be made available to all practitioners
using Sensory Integration through public folders.
Resource Requirements
_______________________________________
STEP 5 Review Date _________________
Risk Rating After Review __
Person/s Responsible ________________________________________________________________
36
The Use of Sensory Integration in Adult Mental Health
Literature and research related to the use of SI focuses mainly on its use with
children and individuals with learning difficulties. SI is a relative new concept
within mental health services although many of this client group may exhibit
sensory processing disorders. Brown, Shanker et al (2006) highlighted the use
and benefits of SI in conjunction with cognitive behaviour therapy in acute mental
health. They found SI helped individuals to regulate and modulate sensory
information which enabled them to engage in meaningful occupations. There was
a reduction in self harm and use of substances as well as less distress and better
interpersonal skills. Using the sensory profile in 2009/2010, they found clients
with borderline personality disorder were sensory sensitive and sensory avoiding
(Brown, Shanker et al, 2006).
An SI approach was adopted by the Trust in the South Staffordshire Mental
Health Division adult acute mental health wards. As recommended by the
literature, SI was mainly used with service users who had high states of agitation
and anxiety which resulted in them self harming. The concept of SI was
explained to service users and then they identified behaviour and emotions
whereby their senses were over alert and under alert and how they felt and
behaved when they were in the ‘just right’ zone. Service users then focused on
their different senses and identified sensory activities to increase and decrease
their sensory alertness levels. For example, loud dance music could make
senses more alert whereas relaxing, calm music could decrease alertness levels.
Their behaviour and emotions would alter depending on the sensory information
they were receiving which they governed themselves. Service users were
encouraged to use a sensory soothe box which contained sensory items for them
to use when they were in low or high alertness states. Service users have found
this approach very useful. This is how one service user identified her experience
of SI.
“During my stay at St Georges Hospital on Brocton Ward, I was introduced to my
appointed Occupational Therapist. My OT encouraged me to use a range of
relaxation techniques to, both pick me up if I was down or calm me if I was
agitated.
One of the methods my OT introduced to me was a soothe box. The soothe box
consisted of a small box which I was to put inside a number of items which, when
anxious or agitated would calm me down or if really low and lacking in motivation,
would raise my levels of motivation.
In my soothe box, I put a stress ball, chocolate, my favourite shower gel, a
massage sponge, pastel colours and watercolour paints with paper, my favourite
perfume, a book by one of my most loved novelist and a note which I wrote on
reminding me of activities which cannot actually be put in the box like walking,
running, hovering, cleaning and last but not least, breathing techniques.
I have found this box a constant source of relaxation and have used these
methods on a daily basis to cope with my illness. Quite surprisingly, I have found
37
this a wonderful means of remembering things that, not only relax me but also
focus my mind and divert it away from more morbid thoughts.
I still use this box to this day and I am due for discharge at the end of August. I
hope it helps other people with mental illness as much as it did myself”
Case Study
Kevin is a twenty year old man referred to the community mental health team due
to symptoms of anxiety and depression. He also has a diagnosis of ADHD. His
symptoms would often result in angry outbursts and he lacked motivation at
times often awakening at lunch time. Kevin appeared to find it difficult to adjust to
his environment and regulate his emotions which may indicate a sensory
processing disorder.
Initially an SI screening tool and observation was used to identify Kevin’s
behaviour. His angry outbursts often resulted in him damaging property which
included him banging his head and punching walls. He reported that he does not
feel pain. He would often bite and chew things such as a pencil or the cuff of his
clothes. He fidgets and is often clumsy and shakes at times. He is forgetful at
times and lacks concentration, usually able to sustain concentration for 30
minutes. He walks up and down the stairs with force and three steps at a time
and often collapses onto furniture. He has specific food tastes, eating bland food
and tends to wear similar clothes, mainly black. He is attracted by noise but
becomes easily frustrated in a noisy crowded room especially in a large busy
supermarket and when queuing to pay for items. The only touch he can tolerate
is from his girlfriend.
The Sensory Profile Self Questionnaire by Brown and Dunn (2002) was also
administered to ascertain more information regarding Kevin’s sensory input. He
scored high on low registration indicating low arousal levels. He also scored
slightly lower in sensory seeking
Consistencies in screening tool and profile:
Footing walking u and down stairs
Difficulty noticing/recognising things / pain
Difficulty wake up in morning
Slow processing information and following tasks / unable to multi task
Likes bland foods
Unsure about smells
Likes dark / same clothing
Avoidance of music / noise at times
The Sensory Profile indicates sensory under-responsive which means he is not
getting enough sensory stimulation to maintain his arousal levels. Some of
Kevin’s behaviour such as his frustration and angry outbursts would also indicate
38
that he is sensory over-responsive, over reacting to some of his emotions and
the environment.
Intervention
For Kevin, a sensory ladder was completed with him to identify sensory stimuli
and activities which would increase and decrease his arousal/alertness levels
and lead to self regulation which would achieve order and a sense of control for
him. A visual diagram of the sensory ladder was devised since Kevin had
difficulty with reading and writing. Kevin identified with the OT how he behaved
when he was under and over alert and in the ‘just right’ zone. Activities were then
identified that would stimulate him or calm him down. When in the ‘just right’
zone, he would go out with his mates, talk to people and have a laugh, clean his
bedroom and make a cup of tea and a bacon sandwich. Thus his social
interactions and functioning were good. When he was under alert, he would be
bored and chew things. To increase his alertness levels, he would splash water
on his face, have a cup of tea or a cigarette. His mum or younger sister would
shout at him in the morning to get up. He also agreed to try some different food.
When Kevin was over alert, he became angry with people and frustrated,
particularly with his computer. Techniques he identified to decrease his alertness
were mainly related to the vestibular and proprioception systems. Activities
included doing weights, riding his bike, swimming and taking things apart eg car
or bike engines. If Kevin’s alertness levels continued to increase, his behaviour
would result in fighting with someone, punching doors and smashing his
bedroom. Sensory techniques that would help at this stage include taking time
out either in his bedroom or going for a walk, playing music and doing breathing
techniques. The OT also talked about organising his room to avoid frustration but
Kevin was not keen on this idea. It was important that Kevin identified activities
that were meaningful to him and that would stimulate his inner drive as well as
being challenging.
39
The Use of Sensory Integration in Learning Disabilities
Case Study
Jason is a 20 year old male with a diagnosis of Aspergers, currently living at a
residential college.
OBSERVED BEHAVIOURS SUGGESTIVE OF SENSORY INTEGRATIVE
DIFFICULTIES
 Complains about smells and noises within his environment.
 Watches television with the volume turned down.
 Struggles greatly with adapting to change of environment.
 Shields his eyes from the sunlight / hood pulled up/ rubs his eyes.
 Presses his forehead onto the table.
 Sudden noise/ vibration will cause Jason to flinch.
 When several people talk at once, Jason will hum or sing to himself.
 Difficulties in attending to a task, either academic or functional.
 Easily distracted by other students / people.
 Becomes withdrawn / reluctant to engage in interaction or activity.
ASSESSMENT
Jason’s presentation was considered in light of sensory integration theory. The
Sensory Integration Inventory Revised (SII-R) (Reisman and Hanschu 1992) was
utilised to establish under which domain the majority of Jason’s sensory
associated behaviours lie.
The SII-R is a standardised assessment and is indicated for use with all ages. No
formal training in administrating this assessment has been undertaken therefore
results should be used for guidance only. The assessment relies on the
observation of patterns of behaviour and the identification of meaningful clusters
which can be linked to specific sensory stimuli. It distinguishes between the
different areas of sensory avoidance, which is of particularly interest in Jason’s
case.
The majority of observed behaviours corresponded to a ‘hyper reactive’ sensory
issue, ‘sensory defensiveness’, a subgroup of sensory modulation disorder.
Results were interpreted by a single assessor therefore additional information
was gathered from interviews with Jason’s family members, social worker,
college tutors and formal reports which provided further evidence to support this
hypothesis.
In cases of hypersensitivity, individuals are thought to overreact to insignificant
information from the environment which results in anxiety. He appears unable to
distinguish between relevant and irrelevant environmental stimuli, therefore
becomes overwhelmed or ‘bombarded with information’
Jason’s reactions to the various stimuli within his environment would suggest
olfactory, auditory and visual defensiveness. Although he has difficulty
40
articulating his needs, Jason has already found ways to reduce the stimulation he
encounters (e.g. dust masks to block out smells, covering his eyes/ears,
humming to create ‘white noise’).
INTERVENTION PLAN
The recommended intervention plan would be based on an approach developed
specifically to address sensory defensiveness by Wilbarger and Wilbarger
(2002). Their intervention approach is centred on the belief that sensory
defensive symptoms can effectively be reduced through the frequent
application of specific sensory experiences over a short period of time –
the ‘Sensory Diet’.
‘SENSORY DIET’
The sensory diet includes:
 Identifying experiences or activities that help ground, calm, centre and/or
alert individuals and reduce defensive behaviours.
 Achieving and maintaining an arousal level required to function in a task
It would appear that Jason already employs certain strategies to help himself
return to a sense of calm. He hums and makes mouth noises, and leans into/
presses against objects and furniture, behaviours considered to have a calming
or organizing effect. Proprioception and movement are thought to reduce sensory
defensive symptoms through the global integrative effects these inputs have on
the Central Nervous System (Wilbarger and Wilbarger 2002). Many of Jason’s
preferred activities (particularly gym work, lifting weights, and drama / movement
workshops) offer proprioceptive and movement functions. Jason’s sensory diet
should incorporate his interests in such areas, aiming to decrease sensory
sensitivities.
The daily routine is a key area for implementation of the sensory diet. This should
be constructed according to the individual’s sensory processing needs. Jason
needs to be assisted in developing a routine that explores his sensory
preferences, and encourages development through adaptive responses.
FURTHER INTERVENTION
Further work needs to be done to explore:
 Awareness of arousal levels.
 Calming strategies which may assist him to cope with unpredictable
sensory stimuli.
 Alerting strategies for occasions when increased arousal is required.
 Possible environmental adaptations that would provide Jason with the
right level of stimulation to maintain optimal arousal and promote
functioning, and limit distressing stimuli wherever possible.
41
The Use of Sensory Integration in Learning Disabilities
Case Study
Brian
Brian is a 54 years old with a diagnosis of a severe learning disability and autism
and is known to the community learning disabilities team. Brian lives in a home
with two similar aged males and requires assistance with all personal care. Brian
cannot communicate using speech, but has a little understanding of Makaton.
Referral to OT
Brian’s key worker felt he would benefit from a multidisciplinary approach and
referred him to OT. On assessment the OT found that Brian had very few
opportunities to participate in purposeful activity and was rarely taken outside his
home. Brian’s behaviour was described as challenging as he often pulls peoples
hair and showed other signs of aggression.
Thinking Sensory
It was felt that Brian’s behaviour may be sensory in nature and hypothesised that
SI could provide meaningful activity, improve sensory processing and reduce
challenging behaviour. Ayres theory would suggest that Brian’s behaviours are
‘self regulatory’ to compensate for an over or under response to sensory
stimulation which helps him to produce a more functional arousal level.
Sensory Integration Inventory
The Sensory integration inventory was used with Brian and identified clear
clusters of behaviour under the ‘sensory modulation’ domain. The clusters
highlighted that Brian was hyper-reactive to tactile stimuli and hypo-reactive to
vestibular and proprioceptive stimuli. These were noted as Brian avoided others
touching him by pushing, pinching or biting them. Brian was seen to stimulate
his vestibular system by rocking and running and his proprioceptive system by
self injurious behaviours such as butting his body against the back of his chair
and clenching his teeth when angry.
Faulty Modulation
Modulation describes the Central Nervous Systems constant adjustments to
sensory input, filtering out unnecessary input so that a person can function.
Sensory modulation disorders are observed when either too much or not enough
input is filtered out reducing ability to concentrate and be at ease.
Behavioural Responses
To explain the behavioural responses to sensory input links are made to different
areas of the brain:
Limbic System: Integrates inner and outer world experiences. Within the limbic
system is the Amygdala and Hippocampus.
42
Amygdala: Has a function in social behaviour – the basal lateral region of the
amygdala is thought to be where sensory input is interpreted and assigned and
emotional meaning.
Hippocampus: Together with the central nucleus of the amygdala the
hippocampus controls the function of the nervous system.
Reticular formation and frontal cortex: Links between the limbic system and
these areas moderate and inhibit emotions.
Temporal Lobe: Connections between the amygdala and hippocampus to the
temporal lobe (essential for memory) are inferred to link sensory input to previous
experiences.
Recommendations from Assessment
Recommendations were delivered to carers in a training session and OT
assistants made regular visits to the home to support the recommendations. It
was recommended that Brian should have the opportunity to experience
vestibular and proprioceptive input as part of his daily routine. e.g. deep pressure
massage to his head and shoulders to have a calming effect on the tactile
system, walks with heavy rucksacks, or gardening. For vestibular input it was
suggested activities that promote big movements such as dancing or
trampolining were incorporated into the day or more calming activities like using
a rocking chair or having a journey in the car or bus.
Outcome
It was hypothesised that vestibular and proprioceptive input will help to organise
the central nervous system and reduce Brian’s challenging behaviour. Any
permanent benefits of SI will suggest that Brian has been able to produce an
‘adaptive response’ to sensory input which is reliant on the plasticity of the CNS
(ability to change with person-environment interactions). The overall result being
the aim of the OT treatment:- for Brian to engage more successfully in purposeful
activity.
43
The Use of Sensory Integration in Older Adults
Bert is an inpatient on an older adult mental health challenging behaviour
assessment unit. He is occupational deprived, has limited interaction and
engagement with others, the environment and in activities of daily living. His
behaviour is seen to be of a challenging nature effecting interactions and
interventions daily. Bert spends the majority of his time lying down on his bed in
his room where he asks to be left ‘alone’.
Bert was admitted to the assessment unit in January 2006 and was detained on
Section 2 of the Mental Health Act 1983. He has a diagnosis of Vascular
Dementia and presents with symptoms of depression.
The assessments and tools that were used within this case was the Sensory
Integration Inventory – Revised For Individuals with developmental disabilities
(Reisman, Hanschu, 1992) and the Sensory Integration Inventory Interpretation
Form (Dido Green 2.00 adapted from Chu and Green 4.96). Bert was unable to
communicate his needs, difficulties and sensory dislikes and likes although
through observations assumptions were made. ABC charts were used with Bert
to attempt to collect observational information on his everyday behaviour and
identify what triggers Bert’s aggression.
Bert is physically aggressive to anyone that is within his reach by hitting and
scratching them. This could be Bert’s response to calm himself when he is being
moved or he could be seeking stimulation through tactile and proprioceptive
feedback. He asks to stay in his bedroom, choosing to lie down on his bed for the
majority of the time in a foetal position. He appears to be sleeping although
through observations it became evident that Bert is awake, as he opens his eyes
and talks to himself.
Sensory Assumptions
Applying this behaviour to sensory modulation Bert could be in a under
responsive state or he could be curling his body into a foetal position to calm
himself by providing proprioceptive feedback. He may be attempting to organise
and adjust his responses to sensory stimuli and his environment. Bert has no
independence and does not engage in any occupation. This may be related to
his cognitive impairment and possible praxis difficulties in motor planning or it
could relate to feelings of fear when he moves to engage in activities.
Bert is doubly incontinent and at times smears faeces on the floor and walls.
Upon observation this mainly occurred when he was moved to another room or
following intervention. This could be an attempt to self regulate if he is having
sensory modulation difficulties. He refuses most diet and fluid by throwing the
food and drink along the floor and up the wall and due to this has lost a large
amount of weight. Once he has finished his food and drink the crockery is thrown
44
up the wall. This could be a process to regulate himself following sitting up to eat
or it could be another opportunity to seek some feedback from his environment.
Bert displays incomprehensible content of speech and becomes agitated during
conversations. This could be linked to expressive dysphasia which presents itself
as difficulties in putting words together to form a sentence. When Bert becomes
aggressive this could be attributed due to a lack of insight into his language
difficulties and a build up of frustration. Staff may exacerbate Bert’s frustration, as
their understanding is that he is being ‘difficult’ and will continue to respond to
Bert’s questions often displaying their frustration at the content. Bert may
understanding what is being spoken to him however his response may not make
sense to staff although he may think he is responding appropriately.
Bert walks with an over arching gait which presents as a high stepping motion.
He walks with assistance over a small distance and drops his body to the floor,
so that staff can not hold his weight. When Bert chooses to leave his room he
shuffles on his bottom to the door and out into the corridor. He only stays here for
a short period of time then shuffles backwards to his bed and returns to a foetal
position. Bert could be seeking the calming or self regulating influence of the floor
as a response to fear when being moved or when he is walking. He may be
experiencing discrimination difficulties and not being able to make sense of the
information being processed through walking.
When referring to the scoring criteria used in a pilot study for gravitational
insecurity specifically focusing on behavioural categories, Bert displays all the
reactions noted. These are refusing to engage in activity, directing verbal and
physical anger towards individuals who interact with him, placing self on the floor
when being assisted to walk, shuffling on his bottom on the floor when he wants
to go out of his bedroom and demanding to be returned to his bed when he
leaves his room (May-Benson T A and Koomar J A 2007).
Neurological Assumptions
Due to the nature of Bert’s diagnosis of vascular frontal dementia it is necessary
to identify areas of the brain that can be affected through this condition. Damage
in the frontal area of the brain affects movement, behaviour, personality,
emotional control and language. Bert displays difficulties in initiation to engage in
tasks, impaired memory, anti-social behaviour (aggressive physically and
verbally) and expressive dysphasia (Haslett et al 1999).
Links can be made to the limbic system within Bert’s brain as this is responsible
for learning, memory, aggression, expression of emotion, motivation, eating and
drinking. The limbic system enables links between past experience and the
present. The reticular formation may also be affected as Bert displays difficulties
with his sleep pattern and does not have consistent sleep during the day or night.
45
These systems impact greatly on how Bert is processing his sensory
environment and how his behaviour is adapted to respond (Bundy et al 2002).
Bert’s cognition is deteriorating and having a huge effect on an individual who at
one time functioned in his world with no obvious difficulties. This potentially
results in Bert experiencing feelings of fear, anger, low-self esteem and
confusion. He is avoiding engaging in any activities and is demanding the
‘womb’ environment on a very basic level. This demonstrated by his choice to lie
down on his bed in the foetal position for approximately 22 hours daily (The
Matrix Model Richter & Oetter 1990). Bundy et al describes the womb
environment as being ‘separate from the world at large and invokes feelings of
security and safety’ (Bundy et al 2002 pg 270).
Chemical Assumptions
The medication Bert is taking may be having an effect on him physically as
antipsychotic drugs block noradrenalin, which can lower blood pressure.
Carbamazepine can have side effects of dizziness, unsteadiness, drowsiness,
nausea, loss of appetite and blurred vision. Bert may be experiencing a
combination of these side effects which could explain his behavioural responses
to walking (The British Medical association 2001).
Interventions and Conclusion
Interventions that could be considered is to introduce to Bert using a weighted
blanket. These blankets are not used as a restraint and can assessed as to what
weight is most appropriate for the individual. The use of this blanket may evoke
feelings of safety, creating a ‘womb’ like environment. This may provide enough
respite for Bert to tolerate movement when self-care is required. It may also give
him more feedback from a proprioceptive view point which may reduce
inappropriate seeking behaviours.
When the blanket was introduced Bert’s behaviour did change, asked for his
blanket every day therefore used it all the time. His levels of aggression reduced
and he was able to engage with staff in activities like listening to someone read,
sitting at a table working out some maths puzzles. Eating at the dinning table with
other residents. The ward purchased another blanket to enable Bert to have
access to one when he choose.
Interventions of self-care were adapted to increase Bert’s tolerance and reduce
risks, for example washing Bert on his bed lying down. This may over time, build
trust between staff and Bert as they are not the ‘culprits’ that move him and
install fear. Alternatively using a wheelchair may reduce fear felt when standing
and walking. Bert has been more inclined to leave his room and join the ward
environment although these are small changes. When utilising these
46
interventions care was taken to ensure Bert’s reactions are not having a
detrimental effect.
Case Study – Use of Sensory Integration with Older Adult Mental Health
The term Sensory Integration was originally used by Dr Ayres in 1963 and
founded in the neuroscience of the time. She hypothesised that dysfunction in
Sensory Integration could be seen as difficulties affecting function. The theory
had five tenets; that the central nervous system is plastic, that Sensory
Integration develops, that the brain functions as a whole, adaptation is necessary
for Sensory Integration, and that people have an innate drive to act upon their
environment.
Jackie (a pseudonym) is 62, she lives with her husband and she has a
diagnosis of advanced early onset Alzheimer’s disease (WHO 2012). The
referral indicated that Jackie was deteriorating quickly. Jackie’s husband did not
want medication nor should it be the first line of therapy (NICE 2011, Alzheimer’s
Society 2012). In a final attempt to keep Jackie at home, a referral was made to
Occupational Therapy for a sensory assessment. Research by the therapist
revealed a study by Robichaud and Desrosiers (1994) into the efficacy of
Sensory Integration therapy on the behaviours of people with dementia
concluded that, this approach had no significant effect. However, they identified
several flaws in their methodology. Research by Schaaf and McKeon Nightlinger
(2007), Potaljko and Cantin (2010), May Benson and Koomar (2010) and Lane
and Schaaf (2007) concurred that Sensory Integration can benefit individuals
who are struggling with the processing and integration of sensory information.
Wider research indicated that sensory stimulation was generally used with this
population (Hume 2010, Hope and Waterman 2012). Using a family centred
approach, and, careful not to distress Jackie further, the therapist used
observations, reports and modelling of behaviours by carers to establish a
possible sensory reason for Jackie’s difficulties (COT 2010). The carers reported
a lady who struggled with movement, she was frightened, and all transitions,
especially getting in and out of bed were difficult. The therapist hypothesised that
vestibular system dysfunction may be a cause for several of Jackie’s problems.
The vestibular system is the subtle ‘‘unifying sense that we are generally
unaware of’’ (Ayres 2005). This system detects motion, gravity and provides us
with our sense of balance. It develops in utero and, with its many reciprocal
connections, it is believed to provide the foundation for many other functions.
Jackie would become distressed very quickly and appeared ‘drunk’, unsteady
and slurred. The vestibular system affects and is affected by the reticular- limbic
systems, the cerebellum and the visual system. Proximity of the vestibular
receptors to the auditory system may indicate that the vestibular system also
affects hearing and consequently speech (Schaaf and Lane 2009, Koziol and
Budding 2012). Jackie appeared unaware of where she was in relation to the
carers. The visual and auditory systems alert the central nervous system to
potentially hazardous distant stimuli. If vestibular dysfunction impacts upon either
47
system this could be dangerous for Jackie. Jackie’s husband described how she
would tire easily and slump onto the chair. The vestibular system enables us to
maintain upright body postures against gravity (Schaaf and Lane 2009, LundyEckman 2013). In addition Jackie appeared to struggle to work out how to get on
the bed; the vestibular system affects praxis directly and indirectly.
Fundamental to her theory, Ayres (2005), hypothesised that all function,
emotions and learning, were founded upon the three senses of the tactile, the
proprioceptive and the vestibular systems. Based upon this the therapist
collaborated with Jackie, her family and carers all interventions were to be
founded in the tactile system.
All transfers and movements were to be facilitated by touch of the deep muscles
at Jackie’s pace. The rhythm of movements was unconsciously set by Jackie, to
facilitate this the carers were to modulate their movements and rate of speech to
accommodate Jackie. Activities were moved to meet Jackie’s needs, personal
care took place at lunchtime rather than in the morning (society’s expectations).
Likewise tactile activities such as sorting were graded into smaller time scales
and changed regularly. Bed transfers were supported by use of Jackie being
supported to sit on the bed and then using a slide sheet she would be positioned
safely. Using the slide sheet allowed the transfer to be slowed and gave Jackie
increased tactile input. Similarly on getting up the tactile system was used.
48
Appendix 1
Infection Control Record Form
Equipment
Date used
Date of cleaned
Signature
49
References and Further Reading
Anstee, H (1999) Physiotherapy in a Multisensory Environment British Journal of
Therapy and Rehabilitation 6 (1) pp. 38-41
Baillon, S. van Dieoen, E. Prettyman, R. Rooke, N. Redman, J. and Campbell, R.
(2005) Variability in Response of Older People with Dementia to Both Snoezelen
and Reminiscence. British Journal of Occupational Therapy. 68 (8).
Baranek, G.T (2002) Efficacy of Sensory and Motor Interventions for Children
with Autism. Journal of Autism and Developmental Disorders 32 (5) pp.397-422
Baker, R., Holloway, J., Holtkamp, C.C.M., Larsoon, A., Hartman, L.C., Pearce,
R., Scherman, B., Johnasson, S., Thomas, P.W., Wareing, L.A., & Owens, M.
(2003) Effects of multi-sensory stimulation for people with dementia, Journal of
Advanced Nursing, 43 (5), pp.465-477.
Baker, R., Bell, S., Baker, E., Gibson, S., Holloway, J., Pearce, R., Dowling, Z.,
Thomas, P., Assey, J., Waring, L. (2001) A randomized controlled trial of the
effects of multi-sensory stimulation (MSS) for people with dementia, British
Journal of Clinical Psychology, 40 (1), pp.81-96.
Barker, R. , Dowling, Z. et al. (1997). Snoezelen: Its Long Term and Short Term
Effects on Older People with Dementia. British Journal of Occupational Therapy,
May, 60(5), pp. 213-218.
Brown, S, Shanker, R, Smith, K & Allwright, H. No date. Personality disorder and
impairment of sensory processing: a clinical review.
[WWW]URL:http://sensoryproject.com/images/stories/sensory/pdf/pdsensory.pdf
[Accessed: 20th January 2008]
Brown, S. , Shankar, R. et al. (2006). Sensory Processing Disorder in Mental
Health. Occupational Therapy News, May, pp. 28-29.
Bundy, A. C., Lane, S, J. et al. (2002). Sensory Integration Theory and Practice,
Second Edition. F. A. Davis Company.
Collier, L., Truman, J. (2008) Exploring the multi-sensory environment as a
leisure resource for people with complex neurological disabilities,
NeuroRehabilitation, 23 (4), pp.361-367.
Ellis, J & Thorn, T. (2000). Sensory Stimulation: where do we go from here?
Journal of Dementia Care, Jan/Feb, pp. 33-36.
Grieve, J. (2001). Neuropsychology for Occupational Therapists: Assessment of
Perception & Cognition, Second Edition. Blackwell Science Ltd.
50
Hamill, L & Sullivan, B. (2005). Stimulating the Senses. Journal of Dementia
Care November/December 11 (120) pp. 37-38.
Haslett, C. , Chilvers, E. R. et al. (1999). Davidson’s Principles and Practice of
Medicine, Eighteenth Edition. Churchill Livingstone.
Henry, J. A. (2001). British Medical Association: New Guide to Medicines &
Drugs. Dorling Kindersley Limited.
Hope, K. W. (1997). Using multi-sensory environment with older people with
dementia. Journal of Advanced Nursing, Vol 25, pp. 780-785.
Hope, K. W. (1996). Caring for older people with dementia: is there a case for the
use of multisensory environment? Reviews in Clinical Gerontology 6; pp. 169175.
Kinnealey, M & Fuiek, M (1999) The Relationship between Sensory
Defensiveness, Anxiety, Depression and Perception of Pain in Adults
Occupational Therapy International 6 (3) p.195-206
Kofman, E.S. (2007) The Effects of Snoezelen (Multi-Sensory Behaviour
Therapy) and Psychiatric Care on Agitation, Apathy, and Activities of Daily Living
in Dementia Patients On a Short Term Geriatric Inpatient Unit, International
Journal of Psychiatry in Medicine, 37 (4), pp.357-370.
Livingstone, G., Johnston, K., Katona, C., Lyketos, C. G. (2005) Systematic
Review of Psychological Approaches to the Management of Neuropsychiatric
Symptoms of Dementia, American Journal of Psychiatry, 162 (11), pp.19962021.
May-Benson, T.A & Koomar, J. A. (2007). Identifying Gravitational Insecurity in
Children: A Pilot Study. The American Journal of Occupational Therapy, 61 (2)
pp. 142-147.
Meesters, C. (1998). Sensory stimulation: a primary need. Signpost April 3(1) pp.
24-25.
Minner, D., Hoffstetter, P., Casey, L. & Jones, D. (2004) Snoezelen Activity: The
Good Shepherd Nursing Home Experience. Journal of Nursing Care Quality, 19
(4), pp. 343-348.
Miller, L. J. , Anzalone, M. E. et al. (2007). Concept Evolution in sensory
Integration: A proposed Nosology for Diagnosis. The American Journal of
Occupational Therapy. 61 (2), pp. 135-140.
51
Ottenbacher, K (1982) Sensory Integration Therapy: Affect or Effect, American
Journal of Occupational Therapy. 36 (9) pp.571-578
Reisman, J (1993) Using a Sensory Integrative Approach to Treat Self-Injurious
Behavior in an Adult with Profound Mental Retardation, American Journal of
Occupational Therapy. 47 (5) pp. 403-411
Reisman, J. E. and Hanschu, B. (1992). Sensory Integration Inventory- Revised
for individuals with developmental disabilities. Hugo MN: PDP Press Inc.
Roley, S. S., Blanche, E. I. et al. (2001). Understanding the Nature of Sensory
Integration With Diverse Populations. Pro-ed, Inc.
Slevin, E & McClelland, A (1999) Multisensory Environments: are they
Therapeutic? A Single-subject Evaluation of the Clinical Effectiveness of a
Multisensory Environment, Journal Of Clinical Nursing 8 (1) p.48-56
Stall, J.A., Sacks, A., Matheis, R., Collier, L., Calia, T., Hanif, H., & Kofman, E.S.
(2007) The Effects of Snoezelen (Multi-Sensory Behaviour Therapy) and
Psychiatric Care on Agitation, Apathy, and Activities of Daily Living in Dementia
Patients On a Short Term Geriatric Inpatient Unit, International Journal of
Psychiatry in Medicine, 37 (4), pp.357-370.
Tortora, G. J. , Grabowski, S. R. (1996). Principles of Anatomy and Physiology,
Eighth Edition. HaperCollins Publishers Inc.
Urwin, R&Ballinger,C.(2005). The Effectiveness of Sensory Integration Therapy
to Improve Functional Behaviour in Adults with Learning Disabilities; Five SingleCase Experimental Designs. British Journal of Occupational Therapy. 68 (2).
pp56 – 66.
Wattis, J. P & Curran, S. (2001). Practical Psychiatry of Old Age, Third Edition.
Radcliffe Medical Press Ltd.
Wilbarger, J. and Wilbarger, P. (2002). The Wilbarger Approach to Treating
Sensory Defensiveness.
Wilhite, B. , Keller, J. M. et al. (1999). The Efficacy of Sensory Stimulation With
Older Adults with Dementia-Related Cognitive Impairments. Annual in
Therapeutic Recreation 8 pp. 43-55.
van Weert, J.C.M., van Dulmen, A.M., Spreeuwenberg, P.M.M., Ribbe, M.W. &
Bensing, J.M. (2005) Behavioural and Mood Effects of Snoezelen Integrated into
24-Hour Dementia Care, American Geriatrics Society, 53 (1), pp.24-33.
52
Summary of some of the literature
Reference
Summary
Minner, D.,
Hoffstetter, P., Casey,
L. & Jones, D. (2004)
Snoezelen Activity:
The Good Shepherd
Nursing Home
Experience. Journal
of Nursing Care
Quality, 19 (4), pp.
343-348.
Quality improvement
project run within a nursing
home for 12 months to
establish is Snoezelen
therapy could reduce
behavioural symptoms of
residents with dementia.
Comfort/discomfort scale
was utilised before, during
and after the use of the
Snoezelen room to
measure both positive
behaviours and negative
behaviours. On average
negative behaviours were
seen to reduce and positive
behaviours increased both
during the session and
after.
Barriers to the use of the
therapy were highlighted
as: adequate staffing (the
use of the room not
prioritised over other care
activities), staff turnover
impacted upon overall
understanding of the
therapy.
Collier, L., Truman, J.
(2008) Exploring the
multi-sensory
environment as a
leisure resource for
Discussion paper
considering the use of
multisensory environments
for people with neurological
disabilities. Collier and
How this applies to
practice
 Relevant to areas of
practice such as
inpatient settings
where a sensory
room is/could be
available
 The article
highlights that
further research
could guide the
development of
guidelines to further
legitimize
Snoezelen
 Highlighted barriers
of use are
potentially relevant
to inpatient settings
e.g. who is trained
to use the room,
how is it accessed
and whether the
culture of the
environment
promotes the use of
the alternative
therapy
 Limitations exist in
generalising the
findings of the
research, and no
statistical analysis
of the findings is
undertaken –
therefore ? are the
positives outcomes
statically significant
 Paper not based on
research and
discussion relates
to brain injury.
However the paper
53
people with complex
neurological
disabilities,
NeuroRehabilitation,
23 (4), pp.361-367.
Truman suggest that MSE’s
are a failure free leisure
activity, and can result in
positive changes in mood,
behaviour and an increase
in attention to their
surroundings. MSE’s are
also suggested to promote
active engagement
enabling a sense of
mastery. Additionally if
graded appropriately MSE’s
can encourage motivation
and ‘Flow’. Other positives
include:
 Few demands
placed upon the
person to verbally
communicate and
rely on memory
 MSE’s can be
catered to personal
taste (e.g. music)
Discussion considers the
need for proper
assessment (without this
the activity is likely to fail).
The AMPS and the Pool
Activity Level is suggested.
Livingstone, G.,
Johnston, K., Katona,
C., Lyketos, C. G.
(2005) Systematic
Review of
Psychological
Approaches to the
Management of
Neuropsychiatric
Symptoms of
Dementia, American
Journal of
Psychiatry, 162 (11),
pp.1996-2021.
A systematic review of the
psychological approaches
in managing
neuropsychiatric symptoms
of dementia. Within these
approaches both
Snoezelen and other
‘sensory stimulation’ such
as massage and music are
included.
Snoezelen: of 6 studies
reviewed 3 were RCTs. 1
small trial found no clear
results while the remaining
2 found disruptive





highlights
similarities of
people with
dementia and those
with a brain injury.
Relevant to areas of
practice such as
inpatient settings
where a sensory
room is/could be
available
Valuable points
raised regarding
adequate
assessment and
useful discussion
regarding the use of
the PAL. An
example of
guidelines for using
an MSE for people
in the ‘reflex’ activity
level is given in the
paper. This clearly
links the theory of
MSE’s to practice.
Based on principles
of OT theory e.g.
leisure, ‘flow’ and
the ‘just right
challenge’
Inclusion of both
Snoezelen and
sensory stimulation
widens application
to environments
without a sensory
room, potentially
allowing application
within both wards
and community
settings.
Some research
considered within
the review is of
limited quality or
54
behaviour briefly improved
outside the treatment
setting; however there was
no effect when treatment
stopped. The further 3
studies including an
uncontrolled trial and 2
case studies found
improvements but no
statistics were provided.
Sensory Stimulation: 3/7
studies were RCTs
decreased agitation was
observed 1 hour post
treatment in one study
while the remaining 2 found
no positive effect. While
one of the remaining
studies highlighted some
improvements post
intervention, the remaining
found either only short lived
benefits or no change.
van Weert, J.C.M.,
van Dulmen, A.M.,
Spreeuwenberg,
P.M.M., Ribbe, M.W.
& Bensing, J.M.
(2005) Behavioural
and Mood Effects of
Snoezelen Integrated
into 24-Hour
Dementia Care,
American Geriatrics
Society, 53 (1),
pp.24-33.
The quasi-experimental
pre-test/post-test design
investigates the
effectiveness of a Snoezel
care plan integrated into
daily care on behaviour and
mood. The research was
undertaken across elderly
care wards and nursing
homes in the Netherlands.
Specific snoezel care plans
were written for participants
based on a detailed life
history and stimulus
preference screening. The
care plan integrates
sensory approaches to
activities of daily living e.g.
how to wake a person up,
dressing ability, perfume,
make up, use of touch,
music and aromatherapy.




generalisation to
wider clinical areas
may not be
appropriate.
The systematic
review includes
other approaches
relevant to OT such
as structured
activity programs.
The multisensory
review concludes
that Snoezelen and
sensory stimulation
may be useful
during the session
but have no longer
term effects. Also
the cost and
complexity of
Snoezelen for small
benefit may be a
barrier to use.
Integrating sensory
approaches into the
24 hour care of
people with
dementia could be
implemented across
both inpatient and
community settings
without the need for
costly sensory
equipment.
However the
research offers little
guidance on how
the care plans were
developed therefore
replication is
limited.
Caution
generalising the
findings is required
and other limitations
55
Baillon, S., van
Diepen, E.,
Prettyman, R.,
Rooke, N., Redman,
J., & Campbell, R.
(2005) Variability in
Response to Both
Snoezelen and
Reminiscence,
British Journal of
Occupational
Therapy, 68 (8),
pp.367-374.
Baker, R., Holloway,
Compared to a control
group residents who
received the snoezel care
plan demonstrated
improvements in apathetic
behaviour, aggressive
behaviour and depression
and mood.
A randomly allocated cross
over design considered the
use of Snoezelen in
dementia care compared to
a control (reminiscene).
Outcomes considered
include: agitated behaviour
(measured before, after and
post intervention); heart
rate (pre, during and post)
and mood and behaviour
(during). The research
found no significant
difference between the 2
interventions in terms of
frequency of agitated
behaviour. Both
interventions resulted in a
decreased heart rate by the
end of the session and
while Snoezelen showed a
greater effect post
intervention this was not
statistically significant. The
research concludes that
both interventions had a
positive effect on mood and
behaviour however
Snoezelen was not more
effective than reminiscence.
The research suggests that
people with severe
dementia may gain greater
benefits from Snoezelen
but there is insufficient
power to provide conclusive
evidence for this.
RCT to assess whether






of the research
need
acknowledgement
Congruent with
person centred care
Snoezelen relevant
to areas of practice
such as inpatient
settings where a
sensory room
is/could be
available
Objective
measurement
considered with use
of heart rate
monitor, possible
replication of this
when measuring
outcomes in
practice
Inclusion of
evaluation of
reminiscence
(chosen as a
suitable comparison
to overcome the
confounding
variable of 1-1
attention) provides
evidence base for
alternative
intervention
Limitations of
research exist due
to small sample
size (n=20),
however UK based
research
Description of multi56
J., Holtkamp, C.C.M.,
Larsoon, A., Hartman,
L.C., Pearce, R.,
Scherman, B.,
Johnasson, S.,
Thomas, P.W.,
Wareing, L.A., &
Owens, M. (2003)
Effects of multisensory stimulation
for people with
dementia, Journal of
Advanced Nursing,
43 (5), pp.465-477.
MSS is more effective than
a control activity (card
games, looking at photos
etc.) in changing behaviour,
mood and cognition of
people with dementia. 8,
30 minute sessions were
implemented over 4 weeks.
Behaviour was rated
before, during and after the
sessions to consider
immediate effect and
assessments considering
cognition, behaviour and
mood were undertaken pre,
mid, post-trial and follow up
assessments were
undertaken. There were
limited short term
improvements for both
groups immediately after
and between the sessions.
There were no significant
differences between the
groups when considering
behaviour, mood and
cognition. However in the
UK behaviour was found to
remain stable for both
groups during the trial but
deteriorated when session
stopped.
Stall, J.A., Sacks, A.,
Matheis, R., Collier,
L., Calia, T., Hanif,
H., & Kofman, E.S.
(2007) The Effects of
Snoezelen (MultiSensory Behaviour
Therapy) and
Psychiatric Care on
Agitation, Apathy, and
Activities of Daily
Living in Dementia
RCT to establish the impact
of multi sensory behaviour
therapy (MSBT) on
agitation, apathy and
ADL’s, compared to a
control. Following MSBT
assessment sessions
participants engaged in 6
sessions while the control
group participated in
recreational activity. The
MSBT group were found to




sensory stimulation
allows for similar
intervention to be
implemented within
both inpatient and
community settings
Wider
generalisation to
previous research
studies due to multinational sample
(94/136 from the
UK)
Highlights benefits
of MSS over activity
based groups for
people with more
severe cognitive
behaviour (apathy
reduced in MSS
participants but
increased for
activity group
participants). The
opposite is found
for participants with
moderate cognitive
impairment. This
can guide practice
dependent on level
of impairment and
links with use of
PAL and VdT
MoCA in practice.
Evidence supports
the use of therapy
with people with
moderate to severe
dementia
MSBT refers to an
approach
integrating
behaviourism and
Snoezelen – the
details of this are
not specified
57
Patients On a Short
Term Geriatric
Inpatient Unit,
International
Journal of
Psychiatry in
Medicine, 37 (4),
pp.357-370.
have significantly improved
levels of agitation
compared to the control
group. Apathy and levels of
independence also
improved compared to the
control group, however the
participants on
antipsychotic medication
had better results than
those not on antipsychotics.
Both groups were found to
have reduced agitation
however it is suggested that
a combination of
pharmacological treatment
and MSBT reduced
agitation more than
standard treatment.
Benefits for people with
moderate to severe
dementia were identified
when stage of illness was
accounted for.
Baker, R., Bell, S.,
Baker, E., Gibson, S.,
Holloway, J., Pearce,
R., Dowling, Z.,
Thomas, P., Assey,
J., Waring, L. (2001)
A randomized
controlled trial of the
effects of multisensory stimulation
(MSS) for people with
dementia, British
Journal of Clinical
Psychology, 40 (1),
pp.81-96.
RCT to evaluate the
immediate effects of MSS
and any carry over effect on
behaviour and mood. 8
sessions of MSS were
compared to 8 activity
sessions chosen following a
key workers assessment on
what the participant might
enjoy and be able to do
(such as a jigsaw). Both
groups were found to have
an immediate effect on
behaviour, participants
were observed to be
happier, more active and
alert and to speak more
spontaneously than prior to
the session. During the 4
weeks of activities, the
MSS group were found to



making replication
in practice difficult
Limitations exist
within the research
related to the pilot
nature of the
research (and ?
intended use of the
research findings),
small sample size
and potential
observer bias
Both activity
sessions and MSS
were found to be
effective
interventions for
people with
dementia with both
resulting in short
term benefits.
The research
postulates that
people with a low
level of functioning
may benefit more
from MSS than
structured activity.
While this is not
supported by
evidence it is
consistent with
practice guidance
58
have greater improvements
in behaviour and mood
compared to the activity
group, however
improvements were lost
when sessions ceased.

such as the PAL
and VdT MoCA.
Limitations within
the research
findings exist due to
small sample size
and possible rater
bias.
59
Directory of Occupational Therapists with Further Training in Sensory
Integration
Mental Health
Julie Barnhouse julie.barnhouse@sssft.nhs.uk
Kerry Langford-Rotton kerry.langford-rotton@sssft.nhs.uk
Heather Lockley heather.lockley@sssft.nhs.uk
Stacey Ker-Delworth Stacey.ker-delworth@sssft.nhs.uk
Beverly Mills Beverly.mills@sssft.nhs.uk
Learning Disabilities
Helen Utterly Helen.uttley@sssft.nhs.uk
60